2. MASTER Respite RFR Cover Sheet~1.doc
DOC document 32 KB Posted
- Solicitation number
- BD-18-1022-DMH08-8220A-18593
- Issued by
- Massachusetts
About this file
This document is a Response Cover Sheet for a Request for Responses (RFR) issued by the Massachusetts Department of Mental Health (DMH) for Respite Services. DMH is seeking to establish a pool of qualified providers from which DMH Areas can purchase Site-Based Respite and/or Mobile Respite Services on an as-needed basis. DMH will enter into a Master Agreement with all qualified providers. The RFR requires bidders to indicate the specific Respite Service they are applying for, the DMH Site Office(s) where services will be provided, and the intended location of the site(s). The cover sheet also includes standard bidder information such as name, address, contact person, and an authorized signature.
The RFR does not provide details on pricing terms, set asides, incumbents, funding requirements and sources, or other salient financial information. The document focuses on the administrative and logistical requirements for submitting a response to the RFR.
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Text version
DEPARTMENT OF MENTAL HEALTH
RFR RESPONSE COVER SHEET
Please use this as the first page of your response materials and the label on your submission package.
RFR Number:
RFR Title:
Please indicate the Respite Service you are applying for below
| Respite Service |
| Check below |
Respite: Mobile
Respite: Site-Based
Include Selection below
| Respite: Mobile |
| Indicate the DMH Site Office(s) where services will be provided |
| Respite: Site-Based |
| Indicate the intended location of site(s) |
Bidder Information
Name:
Address:
Contact Person Name:
Contact Person Phone:
Contact Person Email:
Contact Person FAX:
Signature (must be an individual authorized to negotiate for and execute the contract on behalf of the Bidder):
(Signature)
(Print Name)
(Title)
(Date)
FOR DMH USE ONLY
Date Response Received:
Time:
Received by:
Title/Department:
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